Basic Information
Provider Information
NPI: 1821004508
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JIN
FirstName: PAMELA
MiddleName: Y
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 38 FOXWOOD CIR
Address2:  
City: BRYN MAWR
State: PA
PostalCode: 190101841
CountryCode: US
TelephoneNumber: 6105256582
FaxNumber:  
Practice Location
Address1: 1400 BLACKHORSE HILL RD
Address2:  
City: COATESVILLE
State: PA
PostalCode: 193202040
CountryCode: US
TelephoneNumber: 6103847711
FaxNumber: 6109481464
Other Information
ProviderEnumerationDate: 08/01/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD059577LPAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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